ASAM Submits Comments on Notice of Benefit and Payment Parameters 2023 Proposed Rule; Aims to Expand Equitable Access to Addiction Medicine

Barriers to accessing evidence-based addiction treatment play a significant role in the U.S.’s pervasive health care inequities, which have been exposed and exacerbated by the COVID-19 pandemic. Many of these barriers are due to long-standing inadequate financing of the nation’s addiction treatment infrastructure.  Considering this, on January 26th, ASAM submitted a comment letter to CMS’s proposed rule Patient Protection and Affordable Care Act (ACA); HHS Notice of Benefit and Payment Parameters (the “NBPP 2023 Rule”).

In its letter, ASAM supports, among other things:

• reinterpretation of the ACA’s guaranteed availability requirement; the new interpretation would require issuers to enroll individuals with past-due premiums;
• reversion to pre-2020 non-discrimination protections that would prohibit certain exchanges, insurers, and agents and brokers from discriminating based on sexual orientation and gender identity;
• ensuring nondiscriminatory benefit design through refining the EHB nondiscrimination policy, providing a clear regulatory framework to evaluate plan benefit design and implementation based upon clinical guidelines and evidence; and
• requirements that issuers offer at least one standardized plan at every product network type, metal level, and in every service area where the issuer also offers non-standardized plans and that standardized plans use fixed copays instead of coinsurance.

   

  The letter also documents ASAM’s general support for proposals related to network adequacy regulations, with recommendations for further refinement.  For example, ASAM recommends that the newly proposed “Outpatient Clinical Behavioral Health” category for time and distance standards be split into two groups - one for “Outpatient Clinical Mental Health” providers and another for “Outpatient Clinical Substance Use Disorder” providers.  ASAM also recommends the addition of a separate, individual provider specialty type specific to “Addiction Specialist Physicians” for time and distance standards.  In addition, while expressing support for raising the essential community providers (ECPs) participation rate to 35%, ASAM recommends HHS require qualified health plans to meet this standard for each category of ECP (rather than for all ECPs taken as a whole) to better ensure that qualified health plan enrollees have adequate access to all of the important types of ECPs, including substance use disorder treatment centers.

  Read Letter